A quantitative evaluation of empathy using JSE-S Tool, before and after a Medical Humanities Module, amongst first-year medical students in Nepal.

BACKGROUND: Doctors' empathy: the understanding of patients' experiences, concerns and perspectives, is highly valued by patients yet often lacking in patient care. Medical Humanities has been introduced within undergraduate curriculum to address this lack in empathy. There is a paucity of research on the impact of a course on medical humanities on the empathy of medical students, particularly in South Asia. Here we report on the impact of such an intervention in first-year medical students and aim to help outcome-based medical education and the evaluation and promotion of humanities within medical courses. METHODS: This study is a quantitative evaluation of student empathy before and after a Medical Humanities Module. The study employs the Jefferson Scale of Empathy-Student version (JSE-S). Participants were first-year medical students at Patan Academy of Health Sciences, Nepal. All cohort students were invited to participate and written consent was obtained. Data were collected both prior-to and on-completion-of, a six-week Medical Humanities Module. Pre- and post-module data were analyzed and the resulting empathy scores compared using the paired t-test or Wilcoxon signed-rank test. Subgroup analysis was undertaken to determine the association of the score with gender and preferred future speciality. RESULTS: Sixty-two student responses were analyzed, 32 (52%) of whom were male. In the pre-module scores females had a slightly higher mean score than males:108 and 103 respectively. Participants who preferred people-oriented specialities also scored higher than those preferring procedure and technology-oriented specialities: 107 and 103 respectively. There was a significant increase in mean score for the entire class from pre-module to post-module: 105 to 116, p-value of < 0.001. Mean scores rose from 103 to 116 in males, and from 108 to 116 in females. Participants preferring procedure and technology-oriented specialities showed a significant increase in mean scores:103 to 117, and participants preferring people-oriented specialities demonstrated a smaller increase:107 to 111. CONCLUSIONS: This study provides evidence of the impact of a Medical Humanities course for increasing medical student empathy scores at an institution in Nepal. Teaching of Medical Humanities is an important contributor to the development of empathy in medical students and its widespread expansion in the whole of South Asia should be considered.

Communication skills learning through role models in Nepal; what are medical students really learning? A qualitative study.

BACKGROUND: Communication skills (CS) are important and teachable, however, many Asian medical schools' curricula do not incorporate them. Patan Academy of Health Sciences in Nepal identifies CS within its' aims and curriculum. CS are taught from commencement of medical school and re-emphasised throughout preclinical learning (first 2 years). There is no explicit CS teaching in clinical years but placements allow students to learn through observation. These 'role-modelling' interactions form part of CS learning and development. METHODS: This study is a qualitative evaluation of CS learning in PAHS, through participants' experiences. Through purposive sampling, twenty medical students from 2nd, 4th and Intern years were selected for inclusion. Data were collected via audio recorded, semi-structured interviews, employing a piloted schedule. Transcripts were manually coded and analysed thematically. Codes were organised into themes and subthemes. This paper discusses themes related to role-modelling. RESULTS: The majority of participants described role-modelling in CS learning, recounting both positive and negative incidents, reflected in the themes of; Positive and Negative experiences. Subthemes of Personal Qualities and Inspiring, emerged from positive experiences, describing students' desire to imitate or aspire to be like their role models. Learners reported predominantly negative experiences and interns exclusively so. From these emerged subthemes of; Good doctors but.., Contradictory messages, How not to behave, Unprofessional behaviour and Affect-Emotional Distress. Learners received conflicting messages from observing behaviour contradictory to explicit CS teaching. Many identified learning "how not to behave" from such incidents, however, several described feeling distressed. DISCUSSION: Role-modelling is a powerful and important CS learning tool, seen as positively reinforcing or negatively contradicting explicit CS teaching. Negative modelling created internal conflict, confusion and distress amongst learners, despite its' potential for positive learning. The worldwide problem of negative role-modelling is also prevalent in Nepal. Medical educators need to ensure the explicit curriculum aligns with implicit learning. Clinical tutors must be alerted to their powerful role-model position and supported in developing intentional modelling skills. Learners' reflections upon their experiences should be facilitated, enabling them to critically evaluate observations and hence consciously adopt or reject role-modelled behaviour and attitudes.

Communication skills teaching and learning in Nepal; what are medical students' perceptions and experiences? A qualitative study.

BACKGROUND: Communication skills (CS) are vital for doctors. Indeed, as the most important element of consultations, are highly valued by patients. CS are core, teachable skills, however, have not been widely taught in South Asian medical schools, unlike their western counterparts. Patan Academy of Health Sciences, is one of the first in Nepal to have CS central to its' aims and curriculum. CS are taught from the first weeks of medical school and re-enforced during preclinical study (first 2 years). Our study seeks to explore students' perceptions and experiences of CS teaching in this South Asian, Nepal context. METHODS: This study is a qualitative evaluation of a CS course in Nepal, exploring the experiences and perceptions of participants. The study aims to also identify aspects that were helpful or not for student learning and areas for potential development. A purposive sample of twenty: second, fourth and Intern year students was selected for interview. Data were collected through audio recorded semi-structured interviews following a piloted schedule. Interview transcripts were manually coded and thematically analysed. Codes were arranged into themes and subthemes. RESULTS: The two main themes: 1. Positivity 2. Experiential learning. Results demonstrate participants' positive perceptions of CS teaching: believing it is important, effective, relevant and valuable for personal development. Participants identified experiential learning features as valuable for CS acquisition. Intern students recognised CS relevance and requested expanding teaching to clinical years,incorporating challenging communication scenarios. DISCUSSION: This study shows that PAHS' CS course is well perceived and valuable to learners. Experiential learning is powerful for CS development. Expansion of formal, structured CS teaching through all years in a spiral curriculum, should be considered. Violence towards doctors in South Asia is increasing. Students recognised CS teaching's significance in addressing this. CONCLUSION: CS teaching,still in its' infancy in South Asia, is a pressing issue for medical educators here. Our study provides evidence it is well perceived with positive impacts in this context, particularly when employing experiential learning. Medical schools in south Asia should be encouraged to incorporate and strengthen their CS teaching curriculum. .